Medical Tourism Blog

Q & A with Dr. Jason CH Yap, Director, Healthcare Services, Singapore Tourism Board. Dr. Yap is a public health physician with nearly two decades in healthcare services and currently part of the SingaporeMedicine multi-agency initiative to promote and streamline services offered by Singapore's healthcare providers to international medical travelers.

Dr. Yap is highly suited to be the public face of Singapore's medical tourism not only because of his background which includes stints as the IT Director for the National Healthcare Group and before that with Singapore's Ministry of Health, but also because he sees himself as a product of Singapore's medical travel facilities, considering that his mother traveled from Malaysia to Singapore specifically for his birth.

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Question: Dr. Yap, you are the Director of Healthcare Services with the Singapore Tourism Board. I hope that is correct. So are your duties, and those of your office, tilted more towards healthcare or tourism? Or are you specifically handling medical tourism?
Dr. Yap: Yes, the designation is correct.

First and foremost, STB’s focus goes beyond mere “medical tourism”. We prefer to call it Medical Travel. While many do go on “medical holidays” where healthcare offerings are combined with leisure activities, a great many others travel solely for healthcare. Therefore, what STB takes care of are medical travelers.

Unlike our major competitors, Singapore has an unusual reason for being in the medical travel industry. While the revenue from international patients is naturally welcome in a country that has had to rely on international trade for its national survival, the reality is that Singapore would make more money investing its resources in other directions. However, the national imperative to make and maintain Singapore as an international medical hub arises from the need to look after its own citizens and residents.

Through the decades of strong economic growth, Singapore has invested in its own healthcare system and created one of the best healthcare systems in the world. Singapore sent its doctors overseas to train in the best international centers. These doctors eventually return to upgrade and improve local healthcare services to be on par with where they had trained. All the major healthcare networks are JCI-accredited and Singapore accounts for some one-third of all JCI-accredited healthcare facilities in Asia.

However, with a small population of only 4.5 million residents, Singapore finds it increasingly difficult to sustain the many subspecialties, to maintain the many high-end services and to afford the technology. Thus, the effort to draw international patients is to maintain a critical mass of patients. Ironically, and unlike other countries, Singapore seeks foreign patients in order to serve local patients.

The Singapore Tourism Board (STB) plays an instrumental role to develop and maintain Singapore as a medical hub, not only for international patients, but for medical conferences and training, healthcare consultancy, regional and international headquarters of healthcare organisations, manufacturing of pharmaceuticals and medical devices, etc. STB’s main role is in international marketing and the development of people-oriented services for medical travelers.

Question: What advantages does Singapore hold, for a medical tourist, as compared to countries like Thailand or India?
Dr. Yap: There are several reasons why medical travelers choose Singapore as their choice healthcare destination.

The first and foremost reason is simply that, it is Singapore. Singapore is known for its excellence, efficiency and effectiveness. Having the best international airport, the best airline, and the busiest port in the world, these accolades are evidence of Singapore’s world-class standards and achievements.

The clinical services in Singapore emphasize excellence, safety and trustworthiness, with internationally accredited facilities and renowned physicians trained in the best centers in the world. In 2000, the World Health Organization ranked Singapore’s healthcare system as the sixth best in the world and the best in Asia, and Singapore accounts for one-third of all JCI-accredited facilities in Asia. Beyond international certifications, the quality of healthcare is also seen in published clinical indicators. Many healthcare institutions in Singapore publish their success rates on their corporate websites, and these rates are comparable to, if not exceeding, international standards.

Singapore is a true multi-faceted regional medical hub, not only for patients’ services but also as a meeting place for medical professionals for conferences and training, as a base for healthcare consultancy and operations management, and as the centre for research and clinical trials.

Cost is an important consideration for many international patients. For instance, an angioplasty costs approximately US$57,000-83,000 for an uninsured patient in the United States, whereas in Singapore, it costs only US$13,000, similar to the costs at other major Asian medical travel destinations. So even after factoring in travel and accommodation expenses of the patient and their accompanying persons, the cost savings are still considerable. On top of the affordability, patients in Singapore are assured of world-class treatment and high clinical outcomes.

Finally, Singapore is an international city which welcomes people of all cultures. The Singapore Changi International Airport is connected to some 180 cities in the world, making it highly accessible. Transport and accessibility within the country is equally easy and convenient. English is the first language of education and business. The people in Singapore enjoy high security and low crime. As Singapore is a multi-racial and multi-culturally accommodating city, patients of all race and creed will not find it difficult to meet people in Singapore who speak their language or share their religion.

Ultimately, the medical traveler seeks peace of mind. They do not want to go where there are uncertainties about the quality of care or the safety of the blood, rumors of wars and bombs, government or social unrest, natural disasters, or any concerns about safety for themselves and their families. Singapore is one destination where medical travelers will have no such fears, where they can enjoy peace of mind when their health really matters.

Question: Approximately how many international patients does Singapore receive annually, from which parts of the world, and what are the most sought after treatments by these patients? How much growth is Singapore expecting in this area in the next year and beyond?
Dr. Yap: Based on exit surveys conducted of international patients, out of the nearly 10 million visitors to Singapore in 2006, approximately 410,000 or four percent travelled specifically for healthcare. These patients did not come alone. Approximately 89,000 persons accompanied them on their visits. Another 56,000 received healthcare incidentally when on visits for other purposes. In total, some 555,000 international visitors to Singapore in 2006 were involved in some aspect of medical travel.

The majority of our medical travelers come from the established markets of Indonesia, Malaysia and Brunei, but the list of countries that patients now come from have gone up tremendously in the past half-decade. Singapore continues to be a favored destination for our established markets. Readers Digest in a 25,000-reader survey found that their readers ranked Singapore only after USA as most favored healthcare destination, even ahead of Europe. Consider how the number of healthcare visitors grew from 320,000 in 2004 to 410,000 in 2006, a 28% increase. Some of that increase is accounted by gradual increases in numbers from the relatively stable, established markets, but the remainder is from the rapidly growing markets in ASEAN, the Middle East, South Asia, Russia, etc.

Singapore offers a wide spectrum of healthcare services ranging from health screening and cosmetic surgery to complex specialty care such as ophthalmology, orthopedic surgery, cardiology, cardiothoracic surgery, obstetrics and gynecology, neurology, neurosurgery and oncology amongst others.

Categorically, international patients come to Singapore for four main types of healthcare. They come for essential healthcare where the care is not available in their own country, affordable healthcare where the care is available but not affordable, quality healthcare where the care available locally is or is perceived to be of inferior quality, and premium healthcare where traveling for healthcare is seen as a luxury and adds prestige to the traveling person.

The most significant reason for patients coming to Singapore from the surrounding regions such as Indonesia, Malaysia, IndoChina and India, is for quality healthcare. Many also come for essential healthcare, in particular, complex heart, brain, lung, liver and orthopedic surgeries, organ transplantations, as well as cancer care where their home countries just do not have a similarly high level of medical sophistication, whereas patients from the United Kingdom come to Singapore to avoid long waiting times for surgeries like hip replacements.

For visitors from the United States who usually come to Singapore for orthopedic surgeries and cardiology, the biggest motivation is the cost savings for high quality healthcare, as patients can receive US-standard health care from JCI-accredited healthcare facilities and internationally known doctors at a fifth of the price back home or less.

In total, some 555,000 international visitors to Singapore in 2006 were involved in some aspect of medical travel. Thus, medical travel is a very big market. Singapore hopes to attract at least 1 million medical travelers to Singapore every year starting from 2012.

Question: The Singapore Government seems to be much more involved in promoting medical tourism and getting the various agencies to coordinate in order to provide a better experience for visiting patients. Is this a conscious effort, or is it just the way you do things?
Dr. Yap: While many other countries and regions announce their plans to “go into medical tourism”, Singapore has been quietly doing it all along. The “Whole of Government” approach to supporting Singapore’s international medical travel industry is evident in the SingaporeMedicine initiative.
SingaporeMedicine is a multi-agency government-industry partnership to develop and maintain Singapore as a medical hub and international patient destination. It is led by the Ministry of Health, and supported by three government agencies: the Economic Development Board which develops industry capabilities, the International Enterprise Singapore which fosters regionalization by Singapore’s local health care players, and the Singapore Tourism Board which manages international marketing and associated people-oriented services.
The government agencies work with the local and international healthcare and medical travel industries to ensure that patients are well taken care of. Where there are issues affecting other government agencies (e.g. visas), there is a government-wide consensus and effort to balance the different needs to achieve the best solutions.
Most important of all, as mentioned in Q1, the main motivation behind the government supporting medical travel is that Singapore needs to have patient volumes to maintain the clinical subspecialty expertise, and to gain economies of scale for its technology.
So yes, it is a conscious effort by the government to ultimately provide and sustain the level of clinical expertise and medical care that Singaporeans have since become used to.

Question: We recently interviewed Dr. Milica Bookman, who is doing research on the effect of medical tourism on developing countries. Not to say that Singapore is a developing country, but is medical tourism having any effect on healthcare you offer to your own citizens? If so, could you elaborate on that?
Dr. Yap: As emphasized in Q1, Singapore needs foreign patients in order to serve its own patients.

Question: Please tell us a bit more about Singaporemedicine (Singaporemedicine.com), its mission and activities.
Dr. Yap: Activities undertaken by SingaporeMedicine partners include: Media familiarization trips for international journalists

Participation in healthcare conferences and tradeshows in key and emerging overseas markets such as Indonesia, Malaysia, India, Bangladesh, the Middle East, Russia, and more recently, the United States.

Intensified market development, business development and product development programmes by the Singapore healthcare providers through the support of SingaporeMedicine.

SingaporeMedicine is also working closely with medical institutions to improve international patient support through the provision of international patient liaison services, translation and interpretation services as well as foreign language signages to meet the diverse needs of foreign patients.

Question: We're seeing some employers and insurers showing interest in medical tourism in the U.S. What do you think about medical tourism as an industry? What's the potential? What changes do you see in the near future?
Dr. Yap: The Medical Tourism market is currently valued at US$20 billion annually. Some of these dollars is perhaps hype but the market is obviously significant whatever the actual numbers. These numbers are expected to double by 2010.

The world has flattened for many industries like manufacturing and software engineering, where many companies have gone to China and India respectively. We expect to see the flattening of the world (as in Thomas Friedman’s book) finally reach the healthcare world. Today people in many countries and regions find that the healthcare in their own locality is not accessible, affordable, adequate or acceptable. With the relative ease and low costs of travel today, patients will travel in search of better healthcare.

The medical travel industry has grown in several waves. Initially, there was the local/proximate movements of people to nearby countries for better healthcare, for example, Singapore has been serving the peoples of Indonesia, Malaysia, Brunei and the rest of the ASEAN region long before the term “medical tourism” was ever coined. The people started moving farther afield when they found that they, as consumers, had the ability to choose, which was when individual, often uninsured, Americans started looking to Asia for lower cost healthcare.

The next wave is waiting, when corporate entities realise that, just they can source worldwide for manpower and means of production, they can also start looking overseas for healthcare for their manpower. When corporations, for example in the US and the developed world, started sending their staff around the world for the best and the most affordable healthcare, then truly the world would be flat indeed.

Question: The main worry about medical tourism is that there's no legal recourse in case things go wrong when you opt for surgery abroad. There is realistically very little chance of a successful and timely malpractice suit in most countries promoting medical tourism. What is the status of Singapore, in this regard?
Dr. Yap: Patients travelling for healthcare should by and large be seeking reliable and safe healthcare, and legal proceedings should ideally be a low probability event. Given the excellent clinical outcomes and assured quality of healthcare in Singapore, the chances of patients having to seek legal recourse are significantly lower as compared to other healthcare destinations. However, medicine being what it is, it is not possible to rule out completely the possibility of mishaps and other untoward events. Legal suits related to healthcare services delivered in Singapore would generally be contested in Singaporean law courts. The legal system in Singapore is well known for its impartiality and reliability. In 2004, the Political and Economic Risks Consultancy (PERC) rated Singapore's judicial system as the best in Asia, ahead of Hong Kong and Japan. It also ranked Singapore as the top in consistency of application of laws. In addition, Singapore's legal system has been praised by the International Monetary Fund and the Economic Intelligence Unit. Therefore, the medical traveler can be assured of fairness in the rare event that legal action is appropriate.

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That was Dr. Jason Yap, Director, Healthcare Services, STB. The main advantage Singapore has is that things work efficiently, and on time. A medical tourist in Singapore gets the same, if not better, level of care, at a fraction of the price, has legal recourse which is fair and quick, and best of all, you have the option of recuperating with a great post surgical vacation in Singapore. And an indicator of their efficiency is the fact that the SingaporeMedicine website can be accessed in five languages - English, Chinese, Arabic, Indonesian and Vietnamese. That shows how consumer friendly they are, and how far they are willing to go to attract and satisfy medical tourists. Stay tuned for more interviews.